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Attent ion:

This form is provided for informational purposes only. Copy A appears in red, similar to the

official IRS form. Do not file copy A downloaded from this website. The official printedversion of this IRS form is scannable, but the online version of it, printed from this website, isnot. A penalty may be imposed for filing forms that cant be scanned. See part O in thecurrent General Instructions for Certain Information Returns for more information aboutpenalties.

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or OrderInformation Returns and Employer Returns Online, and well mail you the scannableforms and other products.

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about

printing these tax forms.

http://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.html

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Form 1099-G

2012

Cat. No. 14438M

Certain

Government

Payments

Copy A

FoInternal Revenue

Service Cente

Department of the Treasury - Internal Revenue Service

File with Form 1096

OMB No. 1545-0120

For Privacy Acand PaperworkReduction Ac

Notice, see the 2012Genera

Instructions foCertain Information

Returns

8686 VOID CORRECTEDPAYERS name, street address, city, state, ZIP code, and telephone no.

PAYERS federal identification number RECIPIENTS identification number

RECIPIENTS name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 Unemployment compensation

$2 State or local income tax

refunds, credits, or offsets

$3 Box 2 amount is for tax year 4 Federal income tax withheld

$5ATAA/RTAA payments

$

6 Taxable grants

$7Agriculture payments

$

8 Check if box 2 istrade or businessincome

9 Market gain

$10a State 10b State identification no. 11 State income tax withheld

$Form 1099-G

Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page

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Form 1099-G

2012Certain

Government

Payments

Copy B

For Recipien

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0120

This is important taxinformation and is

being furnished to theInternal Revenue

Service. If you arerequired to file a returna negligence penalty oother sanction may beimposed on you if thisincome is taxable and

the IRS determines thait has not been

reported

CORRECTED (if checked)PAYERS name, street address, city, state, ZIP code, and telephone no.

PAYERS federal identification number RECIPIENTS identification number

RECIPIENTS name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 Unemployment compensation

$2 State or local income tax

refunds, credits, or offsets

$3 Box 2 amount is for tax year 4 Federal income tax withheld

$5ATAA/RTAA payments

$

6 Taxable grants

$7Agriculture payments

$

8 If checked, box 2 istrade or businessincome

9 Market gain

$10a State 10b State identification no. 11 State income tax withheld

$Form 1099-G (keep for your records)

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Instructions for RecipientRecipient's identification number. For your protection, this form may showonly the last four digits of your social security number (SSN), individual taxpayeridentification number (ITIN), or adoption taxpayer identification number (ATIN).However, the issuer has reported your complete identification number to the IRSand, where applicable, to state and/or local governments.Account number. May show an account or other unique number the payerhasassigned to distinguish your account.Box 1. Shows the total unemployment compensation paid to you this year.Combine the box 1 amounts from all Forms 1099-G and report the total asincome on the unemployment compensation line of your tax return. Except asexplained below, this is your taxable amount. If you are married filing jointly,each spouse must figure his or her taxable amount separately. If you expect toreceive these benefits in the future, you can ask the payer to withhold federalincome tax from each payment. Or, you can make estimated tax payments.Fordetails, see Form 1040-ES. If you made contributions to a governmentalunemployment compensation program or to a governmental paid family leaveprogram and received a payment from that program, the payer must issue aseparate Form 1099-G to report this amount to you. If you itemize deductions,you may deduct your contributions on Schedule A (Form 1040) as taxes paid.Ifyou do not itemize, you only need to include in income the amount that is inexcess of your contributions.Box 2. Shows refunds, credits, or offsets of state or local income tax youreceived. It may be taxable to you if you deducted the state or local incometaxpaid on Schedule A (Form 1040). Even i f you did not receive the amountshown,for example, because it was credited to your state or local estimatedtax, it isstill taxable if it was deducted. If you received interest on this amount,youshould receive Form 1099-INT for the interest. However, the payer mayincludeinterest of less than $600 in the blank box next to Box 9 on Form1099-G.

Regardless of whether the interest is reported to you, report it asinterestincome on your tax return. See your tax return instructions.Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsetsshown were made. If there is no entry in this box, the refund is for 2011 taxes.Box 4. Shows backup withholding or withholding you requested onunemployment compensation, Commodity Credit Corporation (CCC) loans, orcertain crop disaster payments. Generally, a payer must backup withhold oncertain payments if you did not give your taxpayer identification number to thepayer. See Form W-9 for information on backup withholding. Include thisamount on your income tax return as tax withheld.Box 5. Shows alternative trade adjustment assistance (ATAA) and/orreemployment trade adjustment assistance (RTAA) payments you received.Include on Form 1040 on the Other income line. See the Form 1040instructions.Box 6. Shows taxable grants you received from a federal, state, or localgovernment.Box 7. Shows your taxable Department of Agriculture payments. If the payer shown is anyone other than the Department of Agriculture, it means the payerhas received a payment, as a nominee, that is taxable to you. This mayrepresent the entire agricultural subsidy payment received on your behalf bythenominee, or it may be your pro rata share of the original payment. SeePub. 225and the Instructions for Schedule F (Form 1040) for information aboutwhere toreport this income. Partnerships, see Form 8825 for how to report.Box 8. If this box is checked, the amount in box 2 is attributable to an incometax that applies exclusively to income f rom a trade or business and is not a taxof general application. If taxable, report the amount in box 2 on Schedule C orF(Form 1040), as appropriate.Box 9. Shows market gain on CCC loans whether repaid using cash or CCCcertificates. See the Instructions for Schedule F (Form 1040).Boxes 10a11. State income tax withheld reporting boxes.

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Form 1099-G

2012Certain

Government

Payments

Copy C

For Paye

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0120

For Privacy Acand PaperworkReduction Ac

Notice, see the 2012Genera

Instructions foCertain Information

Returns

VOID CORRECTEDPAYERS name, street address, city, state, ZIP code, and telephone no.

PAYERS federal identification number RECIPIENTS identification number

RECIPIENTS name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 Unemployment compensation

$2 State or local income tax

refunds, credits, or offsets

$3 Box 2 amount is for tax year 4 Federal income tax withheld

$5ATAA/RTAA payments

$

6 Taxable grants

$7Agriculture payments

$

8 Check if box 2 istrade or businessincome

9 Market gain

$10a State 10b State identification no. 11 State income tax withheld

$Form 1099-G

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Instructions for Payer

General and specific form instructions are provided asseparate products. The products you should use tocomplete Form 1099-G are the 2012 GeneralInstructions for Certain Information Returns and the2012 Instructions for Form 1099-G. A chart in thegeneral instructions gives a quick guide to which formmust be filed to report a particular payment. To orderthese instructions and additional forms, visit IRS.gov orcall 1-800-TAX-FORM (1-800-829-3676).

Caution: Because paper forms are scanned duringprocessing, you cannot file with the IRS Forms 1096,1097, 1098, 1099, 3921, 3922, or 5498 that you printfrom the IRS website.

Due dates. Furnish Copy B of this form to therecipientby January 31, 2013.

File Copy A of this form with the IRS by February 28,2013. If you file electronically, the due date is April 1,2013. To file electronically, you must have software thatgenerates a file according to the specifications in Pub.1220, Specifications for Filing Forms 1097, 1098, 1099,3921, 3922, 5498, 8935, and W-2G Electronically. IRSdoes not provide a fill-in form option.Need help? If you have questions about reporting onForm 1099-G, call the information reporting customerservice site toll free at 1-866-455-7438 or304-263-8700(not toll free). For TTY/TDD equipment,call304-579-4827 (not toll free). The hours of operationareMonday through Friday from 8:30 a.m. to 4:30p.m.,Eastern time.